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Hypofractionated radiosurgery has a better safety profile than single fraction radiosurgery for large resected brain metastases

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An Erratum to this article was published on 23 April 2015

Abstract

The purpose of this study is to compare the safety and efficacy of single fraction radiosurgery (SFR) with hypofractionated radiosurgery (HR) for the adjuvant treatment of large, surgically resected brain metastases. Seventy-five patients with 76 resection cavities ≥ 3 cm received 15 Gray (Gy) × 1 SFR (n = 40) or 5–8 Gy × 3–5 HR (n = 36). Cumulative incidence of local failure (LF) and radiation necrosis (RN) was estimated accounting for death as a competing risk and compared with Gray’s test. The effect of multiple covariates was evaluated with the Fine-Gray proportional hazards model. The most common HR dose-fractionation schedules were 6 Gy × 5 (44 %), 7–8 Gy × 3 (36 %), and 6 Gy × 4 (8 %). The median follow-up was 11 months (range 2–71). HR patients had larger median resection cavity volumes (24.0 vs. 13.3 cc, p < 0.001), planning target volumes (PTV) (37.7 vs. 20.5 cc, p < 0.001), and cavity to PTV expansion margins (2 vs. 1.5 mm, p = 0.002) than SFR patients. Cumulative incidence of LF (95 % CI) at 6 and 12-months for HR versus SFR was 18.9 % (0.07–0.34) versus 15.9 % (0.06–0.29), and 25.6 % (0.12–0.42) versus 27.2 % (0.14–0.42), p = 0.80. Cumulative incidence of RN (95 % CI) at 6 and 12 months for HR vs. SFR was 3.3 % (0.00–0.15) versus 10.7 % (0.03–0.23), and 10.3 % (0.02–0.25) versus 19.2 % (0.08–0.34), p = 0.28. On multivariable analysis, SFR was significantly associated with an increased risk of RN, with a HR of 3.81 (95 % CI 1.04–13.93, p = 0.043). Hypofractionated radiosurgery may be the more favorable treatment approach for radiosurgery of cavities 3–4 cm in size and greater.

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Conflict of interest

Ian Crocker serves as a consultant for Varian Medical Systems (Varian, Palo Alto, CA).

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Authors and Affiliations

  1. Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA

    Bree R. Eaton, Michael J. La Riviere, Roshan S. Prabhu, Kirtesh Patel, Shravan Kandula, Walter Curran, Hui-Kuo Shu & Ian Crocker

  2. Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, GA, USA

    Sungjin Kim

  3. Department of Neurosurgery, Winship Cancer Institute of Emory University, Atlanta, GA, USA

    Nelson Oyesiku & Jeffrey Olson

  4. Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, LL2, Boston, MA, 02114, USA

    Bree R. Eaton

  5. Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Sungjin Kim

  6. Southeastern Radiation Oncology Group, Levine Cancer Institute, Charlotte, NC, USA

    Roshan S. Prabhu

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  1. Bree R. Eaton
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Correspondence to Bree R. Eaton.

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Eaton, B.R., La Riviere, M.J., Kim, S. et al. Hypofractionated radiosurgery has a better safety profile than single fraction radiosurgery for large resected brain metastases. J Neurooncol 123, 103–111 (2015). https://doi.org/10.1007/s11060-015-1767-4

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  • DOI: https://doi.org/10.1007/s11060-015-1767-4

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